EFTA01087593

Grant Proposal Cover Page 
Date 
9 September 2013 
I Project Title 
Polio Eradication and Peace and Health 
 
_Organization Name 
International Peace Institute 
(LPI) 
Project Duration (months) 
12 months (2013) 
Institutional official authorized to submit and accept grants on behalf of the organization: 
Prefix 
Ms. 
First Name 
Andrea 
Suffix 
Title 
Address 
Telephone 
Fax 
Email 
 
Web Site 
Project Director/Primary Contact: 
Prefix 
Ms. 
First Name 
Andrea 
Suffix 
Title 
Director, IPI Vienna 
Address 
Freyung 3 / 1010 Vienna / Austria 
Telephone
Fax 
Email 
Web Site 
www.ipinst.org 
Director, IPI Vienna 
Fre 
3 / 1010 Vienna / Austria 
Surname 
Pfanzelter 
I Surname 
Pfanzelter 
Total Cost 
Amount Requested 
of Project 
from Foundation in 
in Dollars 
Dollars (U.S.) 
$5,000,000 
(U.S.) 
$5,000,000 
Organization's 
revenue from last 
audited Financials 
in Dollars (U.S.) 
$9,151,315 
Organization's 
Fiscal Year-
End Date 
December 31, 2012 
U.S. Tax Status (see Tax Status Definitions) 
501(c)(3) Public Charity 
Geographic Location(s) of Project 
Field work: Pakistan, Nigeria, Somalia 
IPI Offices: New York, Vienna 
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IPI PROPOSAL: 
POLIO ERADICATION AND PEACE AND HEALTH 
I. PROPOSAL OVERVIEW: 
IPI's proposal to the Bill and Melinda Gates Foundation (BMGF) consists of two parts: IPI's new model 
project aimed at reducing the security threats related to polio eradication in the few specific localities 
where it is still prevalent (Afghanistan, Pakistan, Nigeria, and Somalia); and a longer-term, overarching 
initiative on peace and health designed to reduce vulnerability and increase resilience by alleviating the 
disease and poor health that threaten stability, and conversely, mitigating the sources of instability that 
threaten health. 
This proposal reflects activities undertaken in 2013, which will serve as the development period of the 
peace and health initiative. In its initial stage, the initiative will build on the Institute's existing work on 
conflict prevention, mediation, peacebuilding, and humanitarian affairs, but IPI will now explore how 
these tools can be used to reduce the impact of conflict on health and development, particularly in 
fragile states. 
The polio eradication component, which IPI began work on in 2013, is the first major new initiative under 
the work stream, and will serve as a pilot project for future work. Going forward, IPI plans to launch a 
series of projects that relate to the link between peace and health, including: natural disasters (and 
humanitarian affairs); development; sustainable urbanization; food and water security; and conflict 
prevention. 
In the long-term IPI envisions that the peace and health initiative will be an essential new piece in IPI's 
work to promote the prevention and settlement of conflict and to reduce risk and vulnerability. This 
multi-year initiative will position IPI to expand its work to build the capacity of international 
institutions—a core component of IPI's mission—to address peace and health issues also. 
Polio Eradication 
A primary goal of the BMGF is to eradicate polio worldwide. Thanks to a highly successful global 
campaign over the past decade, polio has been successfully eradicated in 99.9 percent of the world. 
However, polio remains endemic in three locations: Afghanistan, Pakistan, and Nigeria. In fact, 100% of 
the polio cases in 2012 were found in 54 districts in these three countries. Recently, new cases have 
been identified in Somalia. Therefore, eradicating polio globally and permanently has come down to the 
last "golden millimeter"—reaching a few thousand children in a handful of isolated, unstable, 
inaccessible, and inhospitable communities. 
The areas in which polio is still a problem are geographically dispersed, but they share some significant 
characteristics: they are comparatively small and difficult to access due to insecurity, insurgency, or 
conflict; and the lack of state authority or control has enabled local power brokers to shape the 
discourse. 
In all of these regions, public health is being used as a tool in misinformation campaigns, whether 
intentionally or as a by-product of a broader political or ideological agenda, which has put the health of 
children at risk. Health workers are also at risk. Several health workers involved in the polio eradication 
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campaign were recently killed in Nigeria and Pakistan. In August 2013 Medecins Sons Frontieres 
announced it is closing all its programs in Somalia after a 22-year presence due to attacks on its staff. 
IPI therefore proposes to assist the BMGF to better understand the local conditions, identify the drivers 
that (or who) can turn the situation around, and provide advice on what steps can be taken to improve 
the chances of eradicating polio in the remaining few localities where it is still present. IPI's work will 
involve, inter alia, providing situation assessments of the vulnerable communities, carrying out and/or 
analyzing quantitative surveys of the affected communities, facilitating access to these communities, and 
(based on the knowledge of the local conditions) assisting in the development of communications 
strategies to eradicate polio. 
Peace and Health 
As stated in the World Health Organization's Ottawa Charter for Health Promotion (1986), peace is a 
primary condition for health. Instability makes people and communities more vulnerable to disease, and 
prevents them from living healthy and productive lives. For example, polio is proving hardest to 
eradicate in regions of some of the world's most unstable countries: Afghanistan, Pakistan, Nigeria, and 
Somalia. Conversely, stability fosters an environment conducive to providing humanitarian and 
development assistance. Therefore, IPI is launching a major initiative to better understand the links 
between peace and health, and to generate policy support to reduce vulnerability and increase resilience 
to health-related problems that contribute to instability, and conversely, to mitigate sources of instability 
that threaten health. 
The peace and health initiative aims to become a thought and policy leader on the link between health 
and stability— understanding the links and their negative aspects, and promoting remedial solutions. 
This is vital since peace and health interact in many different ways. The most significant, and malign, link 
is the fact that people are killed, injured, disabled, abused, or traumatized due to armed conflict. Conflict 
prevention, mediation, and peacebuilding are therefore vital for saving lives. In addition, armed conflict 
has indirect effects on global health. These include: 
1) impeding access of health professionals and humanitarian agencies to populations in need 
(conflict-affected countries have on average less than one health professional per 10,000 
people); 
2) "flight" of health professionals from conflict zones for safety issues (health workers are often 
targeted by government security forces as well) as we are currently witnessing in Syria and 
Somalia; 
3) lack of supplies and basic equipment in hospitals and clinics in conflict zones, as well as difficult 
and unsafe access to health facilities for populations in need, also due to deterioration of 
infrastructure and transportation; 
4) decrease in government expenditure on healthcare; 
5) food shortages due to damaged agricultural structures, collapse of the economy, aid deliberately 
withheld, and disruption of the family unit; 
6) three to four times higher under-5 child mortality rates in conflict zones than in the rest of the 
world; 
7) sharp decline in basic childhood immunization in conflict zones; 
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8) highest rates of maternal deaths due to childbirth complications and other debilitating 
conditions in conflict-ridden or post-conflict states; 
9) increased incidents of sexual violence towards women and children, with greater numbers of 
sexually transmitted diseases, as well as physical and psychological trauma; and 
10) increased incidence of infectious diseases (malaria, cholera, measles) during conflict due to 
malnutrition, unsanitary conditions, lack of clean water, etc. 
These factors create a vicious cycle; greater instability endangers health, while greater vulnerability 
(including disease) breeds instability. Indeed, states characterized as fragile or failed (including those 
that have high rates of polio) tend to have far worse population health indicators than states at 
comparable levels of development. As of today, for example, no low-income fragile or conflict-affected 
country has yet achieved a single one of the Millennium Development Goal (MDGs). Poor health 
indicators are a product of inadequate governance and service development. Moreover, fragile states 
tend to be affected by humanitarian crises that endure for years. In other words, a context of continuing 
crises and emergencies, combined with weak or non-existent local and national institutions, can 
undermine health improvements or nullify health investments and programs in the long-term. 
While armed conflict and instability undermine health goals, the opposite is also true. Investments in 
health, conflict resolution, and statebuilding can be mutually reinforcing. Conflict resolution and 
peacebuilding measures can help prevent or lessen the impact of the above negative outcomes of armed 
conflict on public health. At the same time, the position of medical professionals in society, given their 
neutrality, credibility, and equality, can be a precious resource during negotiations, as are health-related 
cease-fires. The fact that health issues are of interest to all warring parties can contribute to this 
advantage. 
Moreover, health investment can contribute to statebuilding and legitimacy of institutions. In the long 
term, stronger healthcare systems can improve the health of the population, leading to greater 
productivity, stronger economies, less violence, and state stability. Evidence also indicates that improved 
health services can increase trust in state institutions, thus contributing to the authority and legitimacy 
of the government. 
In short, while poor health and instability have a negative impact on each other, peace and health are 
mutually beneficial. It is therefore necessary to promote peace as a primary condition for health, and to 
improve health as a way of promoting peace and development. That is the objective of IPI's work on 
peace and health. 
Since this is an ambitious objective that will require significant time, money, and knowledge, IPI 
intends to mobilize resources to launch and develop an institutional framework for monitoring globally 
the link among peace, security, and health, being mindful that these issues are increasingly 
interconnected as starkly illustrated by the situation in Syria and neighboring countries. IPI has 
recently convened several high-level meetings on the humanitarian crisis in Syria (see Annex). 
II. PROJECT DESCRIPTION 
Polio Eradication 
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1. Context 
The effort to eradicate polio globally and permanently has come down to the ability to ensure the 
effective treatment of children in just a handful of districts in the three countries where polio remains 
endemic. The remaining locations of polio cases are highly concentrated in a relatively small number of 
districts where the central government is unable to provide public security and public-health services. 
For example, 23% of all global polio cases in 2012 were reported in just three Local Government Areas of 
Nigeria: Katsina and Batsari in Katsina State and Minjibar in Kano State. In Pakistan, two regions of North 
and South Waziristan in Khyber Pakhtunkhwa (KPK) account for over 40% of Pakistan's polio cases. The 
vast majority of remaining cases are found in the Federally Administered Tribal Areas (FATA), where 
parents are 40% more likely to refuse treatment than in any other part of the country. 
Nigeria 
Nigeria has the highest rates of polio, with the north of the country the main source of polio infections. 
The country accounts for over half of global cases and is the only country with ongoing transmission of 
all three serotypes of the polio virus. Nigeria also has the highest rates of children missed in vaccination 
campaigns and the highest rate of parents refusing to vaccinate their children. Going back more than a 
decade, polio vaccination campaigns in Nigeria have suffered from targeted misinformation strategies 
and attacks by the terrorist group Boko Haram, weak social mobilization campaigns, and lack of 
commitment by some local leaders. Some strategies have also backfired. For example, the tactic of 
awarding higher salaries and bonuses to polio workers in order to encourage health workers to carry out 
vaccinations has not worked. Low-paid healthcare workers are offered extra cash for helping with the 
campaign, and as a result the primary healthcare system in Nigeria, which is very weak, is emptied out 
for days nearly every month. Additionally, it may not help that workers are paid according to how many 
children they reach, with it being reported some vaccinators refuse to accept cards showing children 
have already been vaccinated. 
The percentage of Nigeria's budget spent on social mobilization is less than 5%, significantly smaller than 
that spent on social mobilization in Pakistan. It is reported that even basic community efforts, such as 
polio posters and banners, are conspicuous in their absence. This is a point of concern as Nigeria has the 
highest noncompliance (refusal) rates of any country where polio persists. Refusal to take medicine 
stems from a fear of Westerners and Western medicine, as there is the perception in some communities 
the vaccination campaign is a Western plot to kill Muslim Africans or to make Muslim children sterile. 
In 2013, IPI will conduct a situation assessment in Nigeria, determining the local conditions, particularly 
those that make the affected communities vulnerable and will conduct survey work in the country. This 
work will lay the foundation for continued work in 2014, including facilitation and outreach and creating 
a communication strategy to "turn" opinion in favor of anti-polio vaccinations. 
Pakistan 
A new polio outbreak has occurred recently in North Waziristan, Pakistan, near the frontier with 
Afghanistan. It is in an area where a warlord banned polio vaccinations after it was disclosed that the 
C.I.A. had staged a hepatitis vaccination campaign in its hunt for Osama bin Laden. The warlord, Hafiz Gul 
Bahadur, has banned all efforts until American drone strikes end. This is a significant setback to the 
Pakistan campaign, which has persistently continued its efforts despite the killing of 9 vaccinators in 
December 2012, which has been attributed to the Taliban. 
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As a result of massive international and national efforts and funding, Pakistan was on the verge of 
complete polio eradication. However, a number of factors conspired to complicate the situation and 
increase resistance to the eradication campaign. These included external circumstances like political-
military instability, terrorism, drone attacks and resulting anti-US sentiment, a Taliban-imposed ban on 
the polio-eradication program, and the May 2013 elections which led to changes in government and 
staff. There were also internal factors, including religion-based and traditional factors, as well as 
corruption, poor infrastructure, mis- or under-reporting, and rivalries and jealousies over how polio-
related funds were to be allocated. In light of this, IPI's work focuses mainly on non-medical and non-
technical aspects of the problems IPI identifies and proposes solutions to, within the framework of its 
cooperation with BMGF. 
In Pakistan, IPI has completed a situation assessment and, through fieldwork in the country, has initiated 
facilitation work in the country. No survey work was undertaken in Pakistan, as IPI believes the country 
has already been over-surveyed on polio. The Institute has planned for an additional field trip in late 
2013 to focus on continued facilitation and outreach (eg. how to get the Taliban ban lifted, where and 
how the Pakistan Armed Forces can help in "danger zones", and monitoring concrete measures taken by 
government authorities to improve weak areas already identified). While Pakistan has an adequate 
national communications plan, IPI will also suggest areas of improvement for 2014, based on the 
research findings. 
Afghanistan 
Afghanistan's quest to eradicate polio is inextricably linked to that of neighboring Pakistan. Genetic 
analysis shows clear chains of transmission between the two countries. There are three chains of polio 
transmission in Afghanistan: two are from Pakistan, and the third is indigenous to Afghanistan, making 
the country endemic in its own right. Due to this closely intertwined relationship, future efforts to 
eradicate polio will likely require Pakistani and Afghani vaccination teams on either side of the border to 
coordinate strategy so that no child goes missing in between. As of now, vaccination coverage data 
suggest little improvement in the number of children reached with vaccination and there are indications 
that coverage levels in some districts are falling. 
Inaccessibility is a challenge in implementing vaccination campaigns; however, the main challenge 
antipolio initiatives face in the country are basic leadership and management problems that are not 
properly addressed. In May 2012 it was reported that an Inter-Ministerial Task Force had been formed 
and would direct a whole-of-government approach to polio eradication. Five months later, this Task 
Force had yet to meet. At the same time, the President's launch of Afghanistan's Emergency Action Plan 
is welcome, but the slow pace of implementation is concerning. Additionally, District EPI Management 
Teams (DEMTs) need further strengthening and NGOs implementing the Basic Package of Health Services 
need to be held accountable for achieving higher coverage rates of routine immunization, including 
polio. 
Permanent Polio Teams in southern Afghanistan have long been credited as the program's flagship 
innovation. They have provided polio drops to 146,000 children, including almost 9,000 who had never 
previously received a dose of the vaccine. Key to their success is their low visibility and step-wise 
introduction. However, their geographic coverage is limited, and they are active in only five of the 13 
high-risk districts of southern Afghanistan. 
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IPI's initial focus is on the Pakistan-Afghanistan cross-border aspects, with transmission and re-
transmission since countless children move regularly via unofficial crossings are missing out on 
scheduled anti-polio immunization on both sides of the border. Afghanistan's anti-polio programme is 
proceeding well, with a go-ahead from the Afghan Taliban's Mullah Omar; the Taliban provide a safe 
passage document for health teams (with the condition that no foreigners be involved). 
However, a very important factor is how the post-2014 situation develops after the withdrawal of 
US/NATO troops and what impact this will have on polio eradication. In 2013, IPI will monitor the 
situation to assess post-2014 threats. A mapping exercise will be carried out in 2014. 
Somalia 
Somalia is highly prone to public-health crises, including outbreaks of cholera, typhoid, malaria, and 
measles. Recently the country has seen an outbreak of polio, which as of the end of July 2013 had 
paralyzed 105 children, where previously a case of polio had not been recorded in more than five years. 
Somalia is one of the countries in the "wild poliovirus importation belt"—a band of countries stretching 
from west Africa to central Africa and the Horn of Africa, which are recurrently re-infected with imported 
polio virus. Although the situation varies across Somalia, parts of the country have been torn apart by 
decades of conflict, chronic poverty, inequality, food insecurity, and public-health challenges. It was 
ranked 165th out of 170 in the 2012 Human Development Index in 2010, with 74% living on less than 
US$2 per day. Life expectancy across the country is a mere 50 years and the youth population of Somalia 
(14-29 years) is a disproportionately high 42% of the population. The country is highly prone to 
humanitarian emergencies, particularly drought and famine, due to very low rainfall, the on-going 
conflict, and increasing deforestation. 
It is likely that the greatest challenge in implementing the polio vaccination campaign will be security 
concerns, as foreign aid organizations are unable to access parts of the country still prone to conflict or 
under Al-Shabaab control. Somalia is navigating the most promising landscape for peace and stability 
that the country has seen in more than two decades, but Al-Shabaab remains a major spoiler to all 
peacebuilding and development initiatives in the country. Al-Shabaab has splintered following a "coup" 
which resulted in the killing of one of the group's co-founders, Ibrahim al-Afghani, an Al Quaeda—trained 
fighter who also fought in Afghanistan, and two further leaders have been forced to flee in recent 
months. The splintering of the group has triggered a wave of fresh violence as different factions fight for 
control of power and territory. The recent spate of violence in Mogadishu, the June car-bombing of the 
UN compound, and the shooting at a Swedish diplomat in August are all examples of the risk posed by 
the group. The constant threat has a very real impact on aid and development efforts in the country; for 
example, Medecins Sans Frontieres announced in August 2013 it is closing all its programs in the country 
after a 22-year presence due to attacks on staff. 
In 2013, IPI will conduct a situation assessment in Somalia, determining the local conditions, particularly 
those that make the affected communities vulnerable and will conduct survey work in the country to 
better understand attitudes towards polio eradication. This work will lay the foundation for continued 
work in 2014, including facilitation and creating a communication strategy to "turn" opinion in favor of 
anti-polio vaccinations. 
Common Themes 
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The areas in which polio has been found may be geographically dispersed, but they share some 
significant common characteristics: they are comparatively small, difficult to access, and with little or no 
presence of the state that has allowed local power brokers to define the debate. 
These regions have been subject to longstanding misinformation campaigns, whether intentionally or a 
by-product of a broader political or ideological agenda, and this has resulted in the health of children 
being put at risk. Local governments have been unwilling or unable to provide for the public health of 
their citizens. Non-state actors (i.e. religious, tribal, or community leaders, as well as armed groups) are 
filling this vacuum in a malign way, including by misinforming communities on the dangers of polio and 
the benefit of vaccination campaigns. In turn, in all of the regions families are seen avoiding or refusing 
to have their children vaccinated for polio. 
Additionally, polio workers have been the targets of violence in these areas. In some cases, suspicion and 
misinformation are causing aggression, violence, and murder against those delivering vaccines. Other 
drivers of the violence stem from groups that profit (politically) from the instability created by going 
after "soft" targets, i.e. health workers. While polio is limited to these select regions, their environments 
are not unique, which highlights vulnerabilities that might be exploited in other regions, e.g. the Sahel, 
by groups benefitting from instability and insecurity. 
2. Rationale 
Specific Need 
For future polio vaccination initiatives to be successful in these regions, it is necessary to identify entry 
points that will find support among the affected communities. While short-term intervention strategies 
might provide the surge required to impact the polio eradication campaign, in the long-term there needs 
to be a change in the perceptions that are triggering the resistance to the campaign. As such, it is 
essential to identify entry points that will change social paradigms, breaking down misperceptions and 
misinformation and circumventing security risks. 
Why this project is an effective means to address this need 
In order to move forward, a nuanced understanding of the perceptions and sources of long-term 
miscommunications that have led to families' failure to protect their children from polio is essential in 
identifying project entry points. A number of initiatives have been undertaken in the affected regions, 
but with limited success, and sometimes unforeseen results—as demonstrated by the award of bonuses 
to healthcare workers in Nigeria. 
Lessons learned from eradicating polio in other countries have demonstrated that a prerequisite to a 
successful campaign is public information, communications, and community-level advocacy. This is also 
true in the remaining communities, but the messaging and delivery need to be adapted and customized 
to the prevailing misconceptions and the sources of those misperceptions in the specific communities. To 
be successful, it is essential to have a nuanced understanding of the local conditions, as well as the 
attitudes, perceptions, and experiences of the affected population. 
Intervention at state level and with central government ministries or authorities is necessary but not 
sufficient to reach these communities and to change their views towards polio eradication. In 
encouraging a positive response to anti-polio campaigns, it is essential to understand why people are 
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reacting negatively to the anti-polio campaign, and to take steps to get them to support it and 
participate in it. In the process, it is essential to de-link the polio issues from all others, and thereby 
"depoliticize" it. Thus, a bottom-up approach is required. Without a better understanding of what the 
people in these communities believe about polio and an analysis of social and political dynamics in the 
target communities, it will be impossible to have impact. By understanding the perceptions, it should be 
possible to change perceptions, creating an environment more conducive to the successful 
implementation of the polio eradication campaign. 
Understand perception% target insecurities 
Conflict, 
insecurity, 
absence of state 
Long-term, 
localised 
misinformation 
Fear, mistrust, 
misjudgment 
Build confidence, show results, achieve change 
Geographic locations & the direct beneficiaries 
Geographic locations will be limited to very specific ones in Somalia, Pakistan, Afghanistan, and Nigeria, 
identified through the situation assessments. It should be noted that within these countries, the danger 
of polio transmission exists not only in remote areas with inadequate health facilities but also in urban 
slums and "catchment" areas. 
Direct beneficiaries will be mostly those children who are, for various reasons, currently excluded from 
cycles of polio-eradication programs: as a result of conflict and /or security issues which block access of 
health teams to the children; use of religion-based bans on anti-polio vaccines as part of larger security 
and development issues; remote areas which are difficult to access; under- or misreporting of 
immunization coverage; and corruption issues which affect parts of the chain which makes up the direct 
and correct delivery of anti-polio vaccines. Secondary beneficiaries would be all members of the affected 
communities who would benefit by greater stability, development, and better health. 
Peace and Health 
Instability and insecurity make people and communities more vulnerable to disease, and prevents them 
from living healthy and productive lives. Conversely, stability and peace foster an environment conducive 
to providing humanitarian and development assistance. IPI's peace and health initiative seeks to better 
understand the links between peace and health, and to generate policy support to reduce vulnerability, 
mitigate risks, and increase resilience to health-related problems that contribute to instability, and 
conversely, to mitigate sources of instability that threaten health. In addition to the polio eradication 
project, IPI's work on peace and health in 2013 includes: 
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Humanitarian Issues 
Over the last two decades, the humanitarian sector has expanded considerably, in terms of the number 
and diversity of actors, staffing, funding, and scope of action. While the humanitarian system is growing 
and becoming increasingly complex, so are the needs of populations and the challenges the system faces 
due to global warming, population growth, increased economic and social disparities, geopolitical 
changes, and the global economic crisis. The humanitarian sector has also taken a more central role in 
world affairs. The interconnected nature of challenges and threats in a globalized world requires 
integrated solutions. Although the specificities of a principled humanitarian action have to be carefully 
safeguarded, the humanitarian system cannot work in isolation from other fields such as development, 
peace and security, statebuilding, and human rights. The importance of humanitarian affairs in global 
governance is underscored in the UN Secretary-General's 2012 Five-Year Action Agenda which gives, 
among other priority areas, a prominent place to building a more global, accountable, and robust 
humanitarian system. 
IPI works to better inform the debate on humanitarian issues and to help build consensus toward policy 
development. IPI's Humanitarian Affairs Program provides a broad platform for the humanitarian 
community to exchange views outside of official fora, focusing in particular on engaging countries and 
humanitarian actors from the Global South, including practitioners, in reflections and discussions on 
humanitarian aid, thereby contributing to a more inclusive and universal system. 
Following the publication of the program's flagship paper, Rethinking Humanitarianism: Adapting to 21st 
Century Challenges, published in late 2012, IPI has engaged experts in a conversation on how the field of 
humanitarian affairs has evolved and what principles, institutions, and policies need to be updated. 
The program's Humanitarian Coordinators Series is the only program that hosts the UN humanitarian 
coordinators from the most troubled spots on the globe for an exchange with the New York-based UN 
community. So far in 2013, IPI has hosted Panos Moumtzis, UNHCR Regional Refugee Coordinator for 
Syrian Refugees; Antonio Donini, editor of The Golden Fleece, Manipulation and independence in 
Humanitarian Action; and Peter Maurer, President of the International Committee of the Red Cross. The 
Series will host Ali Al-Za'tari, UN Humanitarian Coordinator in Sudan, in October and Philippe Lazarini, 
UN Humanitarian Coordinator in Somalia, in November. 
IPI's Middle East in Transition project aims to address issues regarding the current humanitarian 
situation on the ground in and around Syria. As the Syrian conflict enters its third year, the enormous 
humanitarian crisis continues. New diseases or diseases that had long been eradicated, such as 
Leishmaniasis (a vector-borne disease that causes welts on the skin), and Scabies, are now developing; 
emergency vaccinations campaigns have been required, given the risk of measles and polio. 
Furthermore, these diseases are starting to spill across borders with the flow of refugees. Longer-term 
health consequences are potentially huge as well, with the conflict taking a heavy toll on mental health 
and causing permanent physical disabilities. Humanitarian agencies have begun taking preventive 
measures in response to these health risks. However, bureaucratic hurdles and difficulties in gaining 
access to populations in Syria, particularly in terms of delivering food, water and health programs, have 
led to an ever-widening gap between needs and resources. The Middle East in Transition project seeks to 
address the pressing need, expressed by humanitarian organizations, for a space to share information, 
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improve co-ordination, and think strategically in non-operational terms with senior actors amongst 
Syria's neighbors, the region and the international community. 
IPI has conducted extensive consultations with senior government officials and representatives of 
international organizations, published a "lessons learned" paper on regionalism and regionalization in 
the Middle East, and held an expert-level retreat at the Greentree Estate in New York. In April, foreign 
ministers and heads or regional and humanitarian organizations were briefed of the findings at a Middle 
East dinner held in Luxembourg on April 21. A follow-up retreat was held in Geneva, Switzerland in June, 
and the findings will be presented to ministers in September, during a ministerial dinner in New York. 
Conflict Management and Resolution 
The field of international conflict management has greatly changed over the past ten years. New conflict 
drivers, such as terrorism, transnational organized crime, and climate change, have emerged alongside 
an increasingly crowded field of mediators and peacebuilders with specialized skills. These factors 
demand increasing attention in peace processes and coordinated engagement across a wider range of 
interventions. In addition, given the frequent use of proxy forces in contemporary conflict, as well as the 
transnational nature of today's threats to peace and stability, mediation and peacebuilding processes 
need to be informed by an understanding of the broader regional context in order to be successful. At 
present, the mandates and resources for conflict prevention, multilateral mediation, and peace 
operations are often inadequate to meet these challenges. IPI's work stream in this area aims to 
strengthen the full spectrum of tools at disposal of the international community to mitigate and resolve 
armed conflict and bring peace and stability. 
Peacebuilding and State Fragility 
IPI's work on peacebuilding and state fragility aims to improve policy, practice, and program 
implementation to support countries attempting to move out of conflict and achieve statebuilding and 
peacebuilding goals. As the fragile states debate moves from the aid effectiveness arena into the UN 
post-conflict intervention, IPI will support key stakeholders in tackling the implementation gap on fragile 
states. 
Building upon IPI's previous work in supporting the UN peacebuilding architecture, IPI will continue to 
address gaps in the UN's own analytical capacity with behind-the-scenes, informal consultations with the 
UN Peacebuilding Commission's (PBC) member states and chairs, the Peacebuilding Support Office 
(PBSO), and other relevant UN Secretariat staff to provide confidential advice and assistance, and 
concise, published analysis. The program maintains flexibility in responding to PBC/PBSO and other UN 
needs by convening strategically relevant seminars, workshops, and policy retreats. 
In addition to supporting the UN Peacebuilding Commission and Peacebuilding Support Office, in 2013 
IPI supported the office of the UN Secretary-General's special adviser on post-2015 development 
planning, Amina Mohammed, with the organization of a workshop on Conflict, Violence, and Instability 
in the Post-2015 Development Agenda. The workshop offered an opportunity for the UN secretariat, 
agencies, funds and programs, with the assistance of outside experts, to bring together the lessons 
learned so far on the interrelationship between peace, security, health, and development and to 
consider strategies for including these issues in the post-2015 development agenda. The workshop also 
aimed to offer input into the final stages of the deliberations of the High-Level Panel of Eminent Persons 
on Post-2015 Development, as well as into the upcoming UN Secretary-General's report on the topic. IPI 
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provided key points from the workshop to the Secretary-General's special adviser and will draft a 
meeting report to inform the upcoming Secretary-General's report on the post-2015 development 
framework, as it relates to violence and armed conflict. 
Policy thinking on fragility has evolved over the past few years. 2011 alone saw the launch of several 
landmark policy reports, from the OECD DAC's Supporting Statebuilding in Situations of Conflict and 
Fragility, to the World Bank's World Development Report 2011: Conflict, Security, and Development—
both the culmination of years of academic and practical research. The policy and program ideas 
embodied in these reports were carried forward by participants in the International Dialogue on 
Peacebuilding and Statebuilding, and the "New Deal for Engagement in Fragile States" endorsed by more 
than 40 countries and organizations at the Fourth High Level Forum for Aid Effectiveness in Busan, South 
Korea, in December 2011. While much work lies ahead to implement the New Deal, it represents a 
substantial commitment to fresh approaches for tackling the complex challenges posed by state fragility. 
But translating these policy agreements into actual changes on the ground will be challenging. Both the 
2011 independent survey of the Paris Declaration and the Fragile States Principles monitoring survey 
demonstrated that donors are falling short of their existing commitments. The challenge now is to 
ensure that the New Deal doesn't fall victim to the same disappointed expectations. Through a 
combination of analytical products, expert advice, and convening, IPI will assist multilateral and bilateral 
development organizations, and the g7+ countries themselves, in absorbing, adopting, and implementing 
the principles generated by these recent policy initiatives. In this work, IPI will also highlight the peace 
and health link. 
In 2013, in pursuit of the objectives stated above, IPI will conduct an analysis of United Nations Security 
Council mandates relating to select g7+ countries. To support key stakeholders in New Deal 
implementation, including bilateral donors, the research will analyze the evolution of specific Security 
Council mandates related to g7+ countries and their relationship/synchronization and potential for 
advancing the five peacebuilding and statebuilding goals of the New Deal. It will highlight examples of 
synchronization and gaps between existing mission objectives and the guidelines coming out of Busan. 
Work on this track in 2013 will include desk interviews with relevant New York—based staff in the UN 
Secretariat, UN agencies, and selected permanent missions on the status, evolution, and impact of the 
Security Council mandates on statebuilding and peacebuilding goals. A policy brief with 
recommendations will be produced in 2013. 
While it is widely acknowledged that local context is a key variable to consider when formulating policies, 
international policymaking mechanisms have yet to fully take into account existing local knowledge, 
expertise, and experience. IPI's "Leveraging Local Knowledge for Peacebuilding and Statebuilding in 
Africa" project intends to address this gap by making African local knowledge and experience in 
peacebuilding more accessible across the continent and to the larger global community. The project will 
look at what kinds of local knowledge and experience exist—especially in local academic circles, but also 
within the practitioner community—and to transfer this knowledge and lessons learned from the 
bottom-up to better inform policy development and decision-making processes. 
This project also expects to contribute to a better horizontal South-South dissemination of local 
knowledge at the sub-regional and continental level by highlighting best practices in a given context that 
may be adapted to other countries. Utilizing local knowledge on peacebuilding and statebuilding could 
contribute to a wider understanding of the underlying causes of conflict and, ultimately, play a vital 
preventive role. Creating stronger horizontal and vertical links between scholars, civil society, 
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practitioners, and policy-makers could enhance the effectiveness of early warning systems and inform 
the conflict prevention work of regional organizations, thereby contributing to more effective and timely 
peacebuilding efforts. 
This broad objective will be achieved through three goals: (1) to facilitate dialogue among African 
scholars and practitioners on their experiences in peacebuilding and statebuilding on the continent; (2) 
to promote the dissemination of this local knowledge and experience to subregional and regional African 
institutions and to the wider global community; and (3) to inform, with these local insights, ongoing 
policy development and actions at the subregional and regional levels aimed at improving early warning 
systems and conflict prevention efforts. 
In 2013, IPI will establish a Virtual Advisory Board comprised of African and international scholars and 
experts and commission four case studies focusing on (a) women- and youth-targeted initiatives 
contributing to inclusive peace- and statebuilding; (b) statebuilding and the eroding effect of 
transnational organized crime; (c) peacebuilding efforts in the aftermath of election-related violence; 
and (d) the use of new technologies to promote peacebuilding efforts. 
Now that Resolution 1325 has been in place for more than a decade, it's time to look carefully at what 
has been accomplished, what has worked and what has not and, most importantly, what needs to be 
done to further protect women in conflict and support their role in the practices of peacekeeping and 
peacebuilding. To this end, IPI invites women actively engaged in preventing and resolving conflict to 
share with the UN community in New York their personal experiences. Speakers include practitioners, 
scholars, policymakers, and senior officials from international organizations. 
Transnational Organized Crime 
IPI's Peace without Crime project focuses on how the United Nations can take a more integrated 
approach to dealing with the problem of transnational organized crime (TOC). In 2012, the project 
published "Spotting the Spoilers: A Guide to Analyzing Organized Crime in Fragile States." In 2013, on the 
basis of this guide, IPI carried out a training course at the Austrian Study Centre for Peace and Conflict 
Research in Stadtschlaining, Austria. A longer course is planned during the first two weeks of December 
2013 on "Organized Crime as a Spoiler for Lasting Peace." The goal is to develop a prototype training 
package that can be used for national training courses, as well as specialized induction courses for 
regional and international organizations. 
In spring 2013, a second publication of the Peace without Crime project was launched in New York. The 
report is entitled The Elephant in the Room: How Can Peace Operations Deal with Organized Crime? It 
looks at the threat posed by organized crime in theatres where the UN has peace operations (including 
case studies of Guinea-Bissau, Haiti, and Kosovo), examines what the UN is doing to address this threat, 
and provides recommendations to improve the effectiveness of the international community's 
preparedness and response. Meetings are planned for the second half of 2013 in Vienna in order to feed 
the observations and conclusions of the report into relevant policy debates and organs. Furthermore, 
lessons that have been learned through the project will be applied to the Sahel, particularly Mali, in a 
study, meeting and report to be prepared in the last quarter of 2013, together with International Alert. 
A third report will be produced in 2013, entitled "Peace without Crime: Toward a More Integrated 
Approach to Dealing with Transnational Organized Crime." This report is designed to contribute ideas to, 
inter alia, the UN Task Force on Transnational Organized Crime. 
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This year, IPI held its annual Vienna Seminar on the theme of "A Dangerous Nexus: Crime, Conflict, and 
Terrorism in Failing States" focusing on the dangerous nexus between crime, conflict and terrorism, 
particularly in failing states — a highly relevant topic due to the increased risk posed by organized crime 
and terrorism, for example in Afghanistan, the Horn of Africa, and the Sahel region. 
IPI is also planning to carry out research on counterfeit medicine, as well as lessons learned from 
international efforts to combat piracy. Furthermore, IPI plans to produce a guidance manual for 
mediators who are working in environments and with actors impacted by illicit activities. 
Peace Operations 
Peacekeeping has proven to be one of the most effective tools available to the UN to assist host 
countries navigate the difficult path from conflict to peace. Today's multidimensional peacekeeping 
operations are called upon not only to maintain peace and security, but also to facilitate the political 
process, protect civilians, assist in the disarmament, demobilization and reintegration of former 
combatants; support the organization of elections, protect and promote human rights and assist in 
restoring the rule of law. 
In the twenty-first century the UN has deployed an unprecedented number of peacekeepers in 
increasingly comprehensive and complex missions. But the need to sustain approximately 100,000 
uniformed peacekeepers who must perform a wide range of tasks is outstripping the willingness and to 
some extent the capacity of the UN's Member States. Capacity constraints have forced UN operations to 
function at well below full strength or deploy troops and police with inadequate skills, training or 
equipment, imperiling those personnel as well as the goals of the mission. 
IPI's main activities in the area of peace operations aims to help increase the number and improve the 
quality of troops and police available for UN peacekeeping. The "Providing for Peacekeeping" project 
will lead to a better understanding of the factors that encourage or discourage states from contributing 
to UN peacekeeping operations, thereby assisting the UN Secretariat to develop tailored outreach 
strategies for individual member states to meet current and future demands in this area. The project will 
examine ways to strengthen relations between the UN and select troop- and police-contributing 
countries, and will help clarify the UN's capability needs and develop a better understanding of what 
resources will be required to fill them. 
In collaboration with the UN Department of Peacekeeping Operations, IPI will continue its "Being a 
Peacekeeper" series of high-level regional roundtable meetings aimed at broadening the base of troop 
and police contributors to UN peacekeeping. Following successful roundtables held in 2011 in Kuala 
Lumpur and in 2012 in Berlin, IPI will organize a Being a Peacekeeper roundtable in South America in 
2013. 
Mediation 
In order to help multilateral organizations cope more effectively with crisis in the Organization for 
Security and Cooperation in Europe (OSCE) area, particularly to break the ice of the so-called frozen 
conflicts, IPI will carry out research to review the current situation (in Nagorno-Karabakh, Georgia, and 
Transdniestria) and consider alternative approaches to unblock current impasses. The project, entitled 
Breaking the Ice, will look at how the mediation and preventive diplomacy functions of the EU, the OSCE, 
and the UN can be strengthened. The project will map out latent conflicts in Europe, review mediation 
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efforts related to these conflicts, explain the issues at stake and the positions of the parties, and explore 
what steps can be taken to prevent the conflicts and/or enhance the mediation processes. On the basis 
of this information, IPI will encourage new thinking on the mediation processes and prepare a series of 
recommendations for each of the conflict situations. Expert level meetings on the Caucasus and Moldova 
will be held in the last quarter of 2013. 
In recent years, important institutional and policy developments have addressed the numerous 
challenges affecting fragile and conflict-affected states. Despite these developments, there are particular 
areas where improvements are still needed. International actors are in constant need of new techniques 
and approaches to conflict mediation. Yet one possible source of fresh perspectives remains largely 
untapped: women. In the 13 years that have passed since the UN's landmark resolution on women, 
peace, and security, there has been little empirical research into women's approaches to high-level 
mediation, partly because of the continuing dearth of women occupying senior peacemaking positions. 
Building on its Women, Peace, and Security event series and its research and programming on mediation, 
IPI seeks to address the gap in current research through a project on Women in Mediation. 
IPI's Women, Peace & Security event series focuses on the role of women in moving forward peace 
processes and contributing to sustainable outcomes, as well as the relationship between conflict, peace, 
and gender. While the UN Security Council Resolution on women, peace and security (Res. 1325) 
signified great progress toward recognizing the importance of women's participation in peace processes, 
more needs to be done to systematically include women in preventive diplomacy, mediation, and 
peacemaking efforts. Furthermore, women and peace and security issues tend to be addressed at a 
relatively late stage of the conflict resolution continuum when it is too late to ensure that their rights and 
needs are considered in peace agreements and political institutions. 
To address conflict prevention and mediation support in 2013, IPI will conduct a project on Lessons from 
Mediation, for which IPI will commission case studies to identify lessons from the UN's and regional 
actors' engagement in Libya and Yemen. For the study on Libya, IPI seeks to analyze the role of the UN 
and its value added during the transition in Libya, and identify lessons that can be learned for future UN 
engagement in similar contexts. IPI's paper on Yemen will provide a critical analysis of the mediation 
process, and explore ideas and develop recommendations for mediation practices to arrive at 
sustainable solutions. 
Sanctions and Incentives 
Sanctions have long served as a tool in the multilateral tool kit to counter threats to international peace 
and security. Drawing on the lessons from the sanctions against Iraq and other countries and armed 
groups in the 1990s, the international community came around to the idea that "smart and targeted" 
sanctions were a better tool for achieving political objectives than the use of indiscriminate measures. In 
2013, IPI is conducting an analysis of sanctions' effectiveness in civil war situations in Africa. The study 
assesses the UN Security Council's sanctions strategy in conflict situations, in order to consider the 
effectiveness of current sanction regimes under the aegis of the Security Council. 
Peace and Stability in Africa 
The past two decades have witnessed the emergence of more peaceful societies, relative democratic 
progress, and high—albeit uneven—economic growth rates in Africa. However, progress remains 
hindered by persistent armed conflicts, bad governance practices entertained by self-serving political 
elites, the utilization of natural resources to trigger and fund violent conflicts, as well as the politicization 
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of ethnic and religious identities. The expansion of "ungoverned spaces," the multiplication of 
transnational criminal networks, combined with states' weak governance and security structures, all 
contribute to creating a wide network of instability that gradually erodes African countries' ability to 
achieve sustainable peace, security and development for all. 
Several of the countries in the "wild poliovirus importation belt" are located in the Sahel-Sahara region, 
which is in the midst of an ongoing humanitarian crisis. IPI is currently carrying out a project to devise 
appropriate strategies to tackle the political, security, developmental, and humanitarian causes and 
consequences of the crisis in the Sahel-Sahara. The complex and multifaceted crisis in the Sahel-Sahara 
region remains high on the agenda of the international community. While insecurity with the rise of 
radical Islamism and transnational criminal activities remains a serious concern, particularly in northern 
Mali, a combination of drought, flooding, and poor government capacities continues to fuel a 
humanitarian crisis. This crisis has thus far resulted in 18.7 million people facing food and nutrition 
insecurity and more than 1 million children under the age of five being at risk of acute malnutrition. In 
2013 IPI convened a seminar on "Security and Development in the Sahel-Sahara Region" in Niamey, 
Niger. The seminar highlighted the challenges that state weakness poses to security and development in 
the region—namely, the impact of poor governance, corruption, political marginalization, and limited 
government legitimacy on already vulnerable economic and social contexts. Another key outcome of the 
meeting was to identify the challenges that have the potential to hinder the effectiveness and the 
coordination of the various national, regional, and international responses to the crisis in the Sahel. 
IPI is also undertaking a project on Peace and Security in the Gulf of Guinea. Most countries in the Gulf 
of Guinea remain challenged by bad governance practices, inequalities, and corruption, as well as the 
politicization of ethnic and religious identities. Furthermore, due to lack of economic opportunities, weak 
policing structures and environmental degradation, the Gulf of Guinea increasingly forms part of Africa's 
"ungoverned spaces." Piracy, maritime poaching, and robbery have contributed to creating a wide 
network of insecurity, which facilitates drug, arms, and human trafficking. For the international 
community as a whole, piracy and maritime robbery in the Gulf of Guinea constitute a growing threat to 
regional and international peace and security. IPI's work in this area will aim to contribute to an 
analytical understanding of the challenges facing the Gulf of Guinea. 
Although African issues remain high on the agenda of the United Nations, and in particular the Security 
Council, delegations in New York seldom have the opportunity to discuss in-depth current challenges and 
opportunities in Africa or to engage with actors from the region. In 2013, IPI's project, "Support to 
Dialogue at the United Nations on African Issues," aims to help fill this gap by providing a forum for 
knowledge and experience-sharing between policy-makers, scholars and practitioners from African 
institutions and organizations, and the UN community, including Africa's major donors and strategic 
partners in New York. 
Data Lab 
IPI is mapping global trends and compiling information on areas of vulnerability, drawing on IPI's 
strategic assessments, its Global Observatory, and mapping skills. It is also looking at how technology 
can be used to reduce threats and enhance resilience. This work is being done through IPI's new Data 
Lab. The lab's main goal is to incorporate data science techniques like data mining, visualization and 
machine learning into IPI's ongoing areas of research. IPI Data Lab's first projects are the following: 
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IPI Peacekeeping Database 
This project involves data mining PDF documents released by DPKO, converting them to structured data, 
and incorporating them into a database covering who gives how many personnel to which missions on a 
monthly basis. The project resides on the Providing for Peacekeeping website, created by the 
Peacekeeping and Data Lab teams. Updating is a semi-automated process that also generates a number 
of up to date graphics, as well as a map to visualize geographically the distribution of contributions. 
Compliance with UN Security Council Resolutions Addressing Civil Wars 
IPI has developed the first methodology to determine the level of compliance of warring parties to the 
UN Security Council's demands issued in resolutions since 1989. In order to determine correlates of 
compliance, values for more than fifty variables have been gathered in a database with more than 
1,000,000 data points, including variables relating to: 
• 
characteristics of the civil war addressed by the demand; 
• 
contextual activities of the United Nations related to the conflict; 
• 
circumstances of the drafting and adoption of the resolution containing the demand; 
• 
substance of the resolution and of the demand; 
• 
characteristics of the demand addressees; and 
• 
follow-up, monitoring, and enforcement mechanisms. 
A series of data maps have been produced: The Compliance Map gives the user a geographic navigation 
interface. The heat map can also be used to filter specific country cases and mousing over a country 
gives specific details of compliance and the Council's activities. Additional filters control the time frame 
on view as well as limiting to specific resolutions. The Trends in Compliance shows trends in compliance 
over time. The Carrots and Sticks shows the breakdown of demands that include sanctions, incentives, 
and threats and a breakdown of monitoring mechanism used by the Security Council to gauge 
compliance. The Field Presence shows the number of demands that are adopted in the presence of 
various types of field presence. Additionally, we show the correlation to peacekeeping force sized (both 
UN and non-UN) and compliance, as well as a breakdown of the types of thematic requests contained in 
Security Council demands. 
Overlapping Crises 
The overlapping crises map is an interactive world map that uses available data from the World Bank, 
UNDP, WHO, FAO, and Transparency International, to visualize the most extreme cases of youth bulge, 
poverty, inequality, lack of education, poor public health, corruption, and food and water scarcity. Users 
can overlap layers of various crises to get a sense of the challenges facing each country. The map is 
updated annually as new data are available. 
Conflict Indicators and Forecast 
Catalogue of Indices — The use of indices to measure changes in countries across different policy areas is 
becoming increasingly frequent. From human rights to conflict, from governance to gender, many 
organizations have invested in developing statistical models that derive data from multiple sources and 
rank countries according to their score. The IPI's Data Lab provides the first list of country indices 
available in open-sources. It reviews thirty indices and provides a description of the methodology and 
results. The indices are organized in six categories: 1) Conflict, Fragility, and Instability 2) Environment 3) 
Freedoms and Rights 4) Gender 5) Governance 6) Socio-Economics. In addition, the Data Lab has 
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prepared an interactive world map that shows data from all thirty different indices. Users can also see 
results from combined indices in different thematic categories. 
Machine Learning and Conflict Prediction — This involved our first attempt at aggregating global 
subnational statistics for the application of machine learning predictive algorithms. The initial run 
aggregates a number of sources of satellite derived, national governance and geographical data to the 
district level. A subset of this data (continental Africa) was then used to apply a predictive algorithm of 
conflict for a feasibility and performance test. The outcome was highly feasible but not particularly 
predictive (25% variance explained) due to constraints with test data. Future iterations will focus on 
making data collection and aggregation more efficient and increasing the data used for performance 
gains. The results write-up is being reworked for an article in Stability Journal. 
List of key partner organizations, sub-contractors, and sub-grantees that are critical to this project's 
successful implementation; description of the history and current status of these relationships 
IPI will draw upon its extensive network of contacts within multilateral organizations (particularly the UN 
family), regional organizations, senior officials at various levels of government, specialized health 
agencies, experts, and representatives of civil society. IPI will also seek to partner with the World Health 
Organization (WHO), the United Nations Children's Fund (UNICEF), and the International Committee of 
the Red Cross (ICRC), as well as other relevant NGOs and civil society. 
Over the years, IPI has established a network of representatives from humanitarian and health 
organizations, who frequently participate in and contribute to IPI's events and meetings, as well as its 
policy and research outputs. For example, IPI's Humanitarian Affairs program has worked closely with 
the ICRC Delegation to the UN in New York, conducting consulations and outreach on the Institute's 
program matters and outputs. In particular, IPI's flagship humanitarian affairs publication, "Rethinking 
Humanitarianism: Adapting to 2rt Century Challenges," acknowledges the contribution of a 
representative of the ICRC delegation who provided invaluable substantive comments and contributions 
to the report. Most recently, IPI and the ICRC co-organized a policy forum in New York on March 19, 
2013 to commemorate the ICRC's 150 years of humanitarian action and to discuss lessons learned and 
experiences acquired in the course of ICRC's years in the field. 
The Institute is also working closely with the ICRC in implementing its project on "The Middle East in 
Transition" (see Annex)—consulting often with ICRC's President and Strategic Adviser on the conceptual 
development, scope, and progress of the project. IPI is also working with UNICEF and WHO on the 
project, as well as other relevant humanitarian and health organizations, who have participated in 
meetings and provided input on the project from its inception. 
III. ALIGNMENT WITH STRATEGY 
Aligns to BMGF goal to eradicate polio as part of Global Development Program 
The BMGF has a proven track record of promoting strategies that aid in the fight to eradicate polio. The 
IPI project aligns to these strategies most closely in the areas of the polio vaccination campaigns and 
legacy planning. The project has the potential to be a pivotal tool in achieving the BMGF priority of 
improving the quality of campaigns in Nigeria, Afghanistan, Pakistan, and Somalia, as well as other areas 
of Africa that are at risk of polio importation. Specifically, it can improve the BMGF's understanding of 
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local social, cultural, political, and religious barriers to improving vaccination coverage, and identifying 
entry points to overcome these obstacles, engaging local stakeholders and communities. Also, IPI 
supports the sanctuary model, emphasizing quality over quantity in vaccination campaigns. This is also 
important in order to avoid vaccination fatigue. Some children are immunized again and again, until the 
families cease to believe it does any good—and then they start refusing. The small number of polio cases 
requires mapping exercises and immunization campaigns to pinpoint which children are not being 
vaccinated (and why), and adopting implementation strategies that are tailor-made to the specific local 
conditions. 
While polio eradication is the focus of this project, like the BMGF IPI is looking to the future and the 
impact that polio vaccination campaigns can have on future healthcare initiatives. Therefore, IPI will 
make an in-depth study (particularly of fragile states) to better understand the links between peace and 
health, and to generate policy support to reduce vulnerability and increase resilience to health-related 
problems that negatively impact stability, and to mitigate sources of instability that negatively impact 
health. Work on this will begin in 2013, with the aim of finalizing the study in 2014. The project will build 
on both the BMGF and IPI's already substantial capabilities, developing a wide range of assets, including 
detailed knowledge of high-risk groups and vulnerable regions, effective planning and monitoring 
procedures, and highly trained technical staff, as well as local and regional technical advisory bodies. 
Furthermore, in line with the BMGF's strategy that taking risks and making non-traditional investments 
can lead to valuable program improvements, the project works by the philosophy that risky investments 
are sometimes essential to ensure that hard-won healthcare gains can be capitalized upon and 
sustained. Yet over the long-term, such investments can reduce risk. 
How this Project fits into events & developments in the field and/or relevant geographic area to 
address the identified need 
In the case of Somalia, this project presents an unprecedented opportunity to collect data on and 
address the challenges posed to polio vaccination campaigns, as well as healthcare in general, as a 
consequence of insecurity and quickly evolving community conditions. In Somalia, the attitudes towards 
polio vaccination initiatives are the newest and freshest, representing the opportunity to study how 
community perceptions regarding polio are developed and how they can be shaped to support 
vaccination campaigns. It also allows for changing these misperceptions and reversing the trend before 
it becomes too entrenched. As such, it is imperative to act quickly. By getting in on the ground at an 
early stage and implementing a project driven by data and in-depth community insight, there is a better 
chance of stemming the tide of negative propaganda and advance the anti-polio campaign. 
Insights gained in Somalia may also be transferable to countries such as Pakistan, Afghanistan, and 
Nigeria that are part of the existing campaign. It may also allow a shift towards a preventive approach in 
countries where similar conditions of underdevelopment, poor reach of government service delivery, 
and growing international terrorist movements may pose a further threat to the global polio eradication 
campaign. In particular, the Sahel countries of Mali, Niger, Mauritania, and Burkina Faso may become 
vulnerable to similar campaigns, as the influence of Al-Quaeda in the Islamic Maghreb (AQIM), which 
shares institutional links with Boko Haram and AI-Shabaab, is growing in the region. 
As a result of massive international and national efforts and funding, Pakistan was on the verge of 
complete polio eradication. However, a number of factors conspired to complicate the situation and 
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increase resistance to the eradication campaign. These included external circumstances like political-
military instability, terrorism, drone attacks and resulting anti-US sentiment, a Taliban-imposed ban on 
the polio-eradication program, and the May 2013 elections which led to changes in government and 
staff. There were also internal factors, including religion-based and traditional factors, as well as 
corruption, poor infrastructure, mis- or under-reporting, and rivalries and jealousies over how polio-
related funds were to be allocated. 
In the case of Afghanistan, the Project will initially focus on the Pakistan-Afghanistan transmission and 
re-transmission aspects, with countless children moving regularly via unofficial crossings, thus missing 
out on scheduled anti-polio immunization on both sides. The project will also consider how the 
withdrawal of ISAF/NATO troops could impact polio eradication. 
IV. IMPLEMENTATION & RESULTS 
Description of how IPI will achieve the Outcomes & Milestones, including Coordination and 
Sequencing 
To carry out the polio-eradication project, a project plan will be employed consisting of four phases: 
• 
Situation assessment: IPI will conduct a situation assessment determining the local conditions, 
particularly those that make the affected communities vulnerable. Who are the powerbrokers 
and what are their incentives to either support or block the polio-eradication campaign? What 
are the risks involved? 
• 
Survey: Survey work is an instrumental component in overcoming cultural barriers. Where 
existing information is insufficient, quantitative surveys of representative samples in target 
communities will be conducted to build community understanding, providing a greater and more 
in-depth knowledge of what communities believe about polio and an analysis of social and 
political dynamics. Questions that may be asked include: what do respondents know about polio, 
its transmission, its stages, it effects and the campaign to respond? Have respondents been 
offered the vaccine? How did they respond? Are they aware of the polio campaign? Who gives 
them their information about polio? What aspects of it have they witnessed and how did this 
affect their knowledge and understanding? Who takes the decisions in the households regarding 
healthcare and child-rearing? Would respondents give the vaccine to their children? What would 
encourage them to do so? How does polio rank against other health concerns? Would they 
choose to vaccinate their children? Women will be the greater focus of this study as it is 
expected that mothers will be those prepared to resist prevailing cultural norms to protect the 
health of their children. Due to the sensitivity of the topic, questions will be couched within a 
broader context of public-health issues, such as maternal and child health, nutrition, and well-
being. 
• 
Facilitation: On the basis of the information provided by the situation assessment and survey, 
we will determine the drivers (particularly key individuals) and entry points for changing 
perceptions and attitudes. As required, IPI will also mobilize high-level contacts between the 
Foundation and relevant government, multilateral, and business leaders. 
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